Characteristics and outcome of prostate cancer with PSA <4 ng/ml at diagnosis: a population-based study

The impact of PSA and digital rectal examination on the risk of prostate cancer specific mortality in men with a PSA level <2.5 ng/ml

INTRODUCTION

It is unknown whether a normal range, diagnostic serum prostate specific antigen (PSA) level's influence on prostate cancer specific mortality (PCSM) is dependent upon digital rectal examination (DRE) findings.

METHODS

Between 2004 and 2007, 9081 men diagnosed with non-palpable (T1c, N=1710) or palpable (T2-T4, N=7371) and non-metastatic prostate cancer (PC) were identified from surveillance, epidemiology, and end results data, selected based on pre-treatment PSA<2.5 ng/ml. A multivariable competing risks regression model evaluated whether DRE findings interacted with PSA level in predicting risk of PCSM.

RESULTS

After median follow-up of 2.83 years, 118 of 548 deaths (21.5%) were due to PC. Increasing diagnostic PSA was associated with increased risk of PCSM (AHR=3.52; 95% CI: 1.25-9.89; P=.017) in men with T1c, Gleason score 7-10 PC, but decreased PCSM risk (AHR=0.66; 95% CI: 0.52-0.83; P<.001) for men with T2-T4 PC and any Gleason score.

DISCUSSION

For men with diagnostic PSA level <2.5 ng/ml and palpable PC, risk of early PCSM increases by 34% for a 1 point decrease in PSA from 2. This suggests the existence of clinically detectable, low PSA secreting disease with an elevated risk of early PCSM, highlighting the importance of the DRE in men with PC and normal range, diagnostic PSA.

A comparative population-based study of prostate cancer incidence and mortality rates in Singapore, Sweden and Geneva, Switzerland from 1973 to 2006

Background

Prostate cancer is the most commonly diagnosed malignancy in men in Sweden and Geneva, and the third most common in men in Singapore. This population-based study describes trends in the incidence and mortality rates of prostate cancer in Singapore, Sweden and Geneva (Switzerland) from 1973 to 2006 and explores possible explanations for these different trends.

Methods

Data from patients diagnosed with prostate cancer were extracted from national cancer registries in Singapore (n = 5,172), Sweden (n = 188,783) and Geneva (n = 5,755) from 1973 to 2006. Trends of incidence and mortality were reported using the Poisson and negative binomial regression models. The age, period and birth-cohort were tested as predictors of incidence and mortality rates of prostate cancer.

Results

Incidence rates of prostate cancer increased over all time periods for all three populations. Based on the age-period-cohort analysis, older age and later period of diagnosis were associated with a higher incidence of prostate cancer, whereas older age and earlier period were associated with higher mortality rates for prostate cancer in all three countries.

Conclusions

This study demonstrated an overall increase in incidence rates and decrease in mortality rates in Singapore, Sweden and Geneva. Both incidence and mortality rates were much lower in Singapore. The period effect is a stronger predictor of incidence and mortality of prostate cancer than the birth-cohort effect.

An Advanced but Traditional Technique of Transurethral Resection of the Prostate in Order not to Overlook Stage T1 Prostate Cancer

INTRODUCTION

A little deeper resection was done during transurethral resection of the prostate (TURP) for benign prostate hyperplasia (BPH) to fill the disparities of reported prevalence rates between latent and incidental prostate cancer, as well as in order not to overlook clinically significant incidental cancer.

PATIENTS AND METHODS

We performed TURP in 995 patients who were diagnosed to have BPH. With a routine TUR setup, first most of the transition and central zones were resected. Then a slightly deeper resection of the residual adenoma and the peripheral zone than in the usual TURP was made. Pathological specimens were collected from 6 different parts.

RESULTS

Incidental cancer was diagnosed in 226 patients (22.7%). Gleason scores were distributed as follows: 6 or less in 150 cases (66.4%), 7 in 68 cases (30.1%), and 8 in 8 cases (3.5%). Even in the patients with lower prostate specific antigen (PSA), patients with incidental cancer and Gleason scores of 7 or more were 142 (21.2%) and 41 (28.9%) respectively at 0 < PSA < 4.0 ng/ml, and 95 (18.7%) and 26 (27.4%) respectively at 0 < PSA < 2.5 ng/ml. Multifocal/diffuse cancer was detected in 84 (37.2%) patients.

CONCLUSIONS

With our method of advanced TURP, we detected incidental cancer at almost the same rate as reported in latent cancer. When TURP is performed, incidental cancer as well as to relieve voiding difficulties must not be overlooked, because there must be a considerable number of clinically significant incidental cancer of higher Gleason scores, and of multifocal/diffuse lesions.

Prolonged remission of fulminant castrate-resistant prostate cancer: a case report

Castrate-resistant prostate cancer (CRPC) is the main cause of prostate cancer (PC) morbidity and mortality. Newer therapies have only modestly improved survival. CRPC patients’ various comorbidities mean one must treat them cautiously. Cyclophosphamide, vincristine, and dexamethasone (CVD) therapy has a favorable risk-benefit profile, and diethylstilbestrol (DES) was used widely in PC. The patient we describe responded remarkably to combination treatment with CVD plus DES. The 77-year-old man had fulminant CRPC with multiple comorbidities and bony metastases in March 2008. In May 2008, his prognosis was dismal: performance status score, 4; pancytopenia; 51 × 109/l platelets; abnormal coagulation profile consistent with disseminated intravascular coagulopathy; and cranial images consistent with dural metastases. We administered one dose of CVD (cyclophosphamide [300 mg/m2 IV], vincristine [1 mg IV], and dexamethasone [0.75 mg PO b.i.d.]) plus DES (1 mg PO b.i.d.). He responded quickly with no clinically significant toxicity. His performance status improved and platelet count increased to 89,000 × 109/l. We administered maintenance CVD (cyclophosphamide, 150 mg/day PO for 21 days every 28 days; vincristine, 1 mg IV weekly; dexamethasone, 0.5 mg PO b.i.d.) plus DES (1 mg PO b.i.d.) for 5 months. In January 2011, nearly 3 years after his initial treatment, he remained alive and well. CVD plus DES may help selected patients with advanced CRPC who are too ill to tolerate or benefit from other therapies.